Diagnostic Imaging Pathways - Dementia

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Population Covered By The Guidance

This pathway provides guidance on the imaging investigation of adult patients with cognitive decline, once systemic causes have been excluded.

Date reviewed: September 2014

Date of next review: 2017/2018

Published: December 2014

Quick User Guide

Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.

SYMBOL RRL EFFECTIVE DOSE RANGE
No radiation None 0
Minimal radiation Minimal < 1 millisieverts
Low radiation Low 1-5 mSv
Medium radiation Medium 5-10 mSv
High radiation High >10 mSv

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Pathway Diagram

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Images

Coming soon

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Teaching Points

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Clinical Assessment and Neuroimaging In Dementia

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Magnetic Resonance Imaging (MRI) with CSF Flow Studies

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Computed Tomography (CT)

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Magnetic Resonance Imaging (MRI)

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Position Emission Tomography (PET) (Fluorodeoxyglucose [FDG])

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Single Photon Emission Computed Tomography (SPECT)

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SPECT Nuclear Medicine Cisternography

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References

Date of literature search: June 2014

The search methodology is available on request. Email

References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

  1. Wortmann M. Dementia: a global health priority - highlights from an ADI and World Health Organization report. Alzheimers Res Ther. 2012;4(5):40. (Review article). View the reference
  2. Practice parameter for diagnosis and evaluation of dementia. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1994;44(11):2203-6. (Consensus statement). View the reference
  3. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ARDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology. 1984;34(7):939-44. View the reference
  4. McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR, Jr., Kawas CH, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7(3):263-9. (Guideline document). View the reference
  5. Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7(3):270-9. (Guideline document). View the reference
  6. Jack CR, Jr., Albert MS, Knopman DS, McKhann GM, Sperling RA, Carrillo MC, et al. Introduction to the recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7(3):257-62. (Review article)
  7. Hyman BT, Phelps CH, Beach TG, Bigio EH, Cairns NJ, Carrillo MC, et al. National Institute on Aging-Alzheimer's Association guidelines for the neuropathologic assessment of Alzheimer's disease. Alzheimers Dement. 2012;8(1):1-13. (Guideline document). View the reference
  8. Villemagne VL, Burnham S, Bourgeat P, Brown B, Ellis KA, Salvado O, et al. Amyloid beta deposition, neurodegeneration, and cognitive decline in sporadic Alzheimer's disease: a prospective cohort study Lancet Neurol. 2013;12(4):357-67. (Level I evidence). View the reference
  9. Jack CR, Jr., Knopman DS, Weigand SD, Wiste HJ, Vemuri P, Lowe V, et al. An operational approach to National Institute on Aging-Alzheimer's Association criteria for preclinical Alzheimer disease. Ann Neurol. 2012;71(6):765-75. (Guidelines document). View the reference
  10. Jack CR, Jr., Knopman DS, Jagust WJ, Petersen RC, Weiner MW, Aisen PS, et al. Tracking pathophysiological processes in Alzheimer's disease: an updated hypothetical model of dynamic biomarkers. Lancet Neurol. 2013;12(2):207-16. (Review article). View the reference
  11. Knopman DS, DeKosky ST, Cummings JL, Chui H, Corey-Bloom J, Relkin N, et al. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56(9):1143-53. (Level I evidence). View the reference
  12. Dubois B, Feldman HH, Jacova C, Dekosky ST, Barberger-Gateau P, Cummings J, et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurol. 2007;6(8):734-46. (Review article). View the reference
  13. Hort J, O'Brien JT, Gainotti G, Pirttila T, Popescu BO, Rektorova I, et al. EFNS guidelines for the diagnosis and management of Alzheimer's disease. Eur J Neurol. 2010;17(10):1236-48. (Evidence Based Guidelines). View the reference
  14. Factora R, Luciano M. Normal pressure hydrocephalus: diagnosis and new approaches to treatment. Clin Geriatr Med. 2006;22(3):645-57. (Review article). View the reference
  15. Bradley WG, Jr., Whittemore AR, Kortman KE, Watanabe AS, Homyak M, Teresi LM, et al. Marked cerebrospinal fluid void: indicator of successful shunt in patients with suspected normal-pressure hydrocephalus. Radiology. 1991;178(2):459-66. (Level III evidence). View the reference
  16. Scheltens P. Early diagnosis of dementia: neuroimaging. J Neurol. 1999;246(1):16-20. (Review article). View the reference
  17. Small GW, Leiter F. Neuroimaging for diagnosis of dementia. J Clin Psychiatry. 1998;59 Suppl 11:4-7. (Review article). View the reference
  18. Jobst KA, Hindley NJ, King E, Smith AD. The diagnosis of Alzheimer's disease: a question of image? J Clin Psychiatry. 1994;55 Suppl:22-31. (Level II/III evidence). View the reference
  19. Jobst KA, Smith AD, Szatmari M, Molyneux A, Esiri ME, King E, et al. Detection in life of confirmed Alzheimer's disease using a simple measurement of medial temporal lobe atrophy by computed tomography. Lancet. 1992;340(8829):1179-83. (Level IV evidence). View the reference
  20. de Leon MJ, George AE, Stylopoulos LA, Smith G, Miller DC. Early marker for Alzheimer's disease: the atrophic hippocampus. Lancet. 1989;2(8664):672-3. (Level III evidence). View the reference
  21. Jagust WJ, Eberling JL. MRI, CT, SPECT, PET: their use in diagnosing dementia. Geriatrics. 1991;46(2):28-35. (Review article). View the reference
  22. Bermingham SL. The appropriate use of neuroimaging in the diagnostic work-up of dementia: an economic literature review and cost-effectiveness analysis. Ont Health Technol Assess Ser. 2014;14(2):1-67. (Level II evidence). View the reference
  23. Jack CR, Jr., Petersen RC, O'Brien PC, Tangalos EG. MR-based hippocampal volumetry in the diagnosis of Alzheimer's disease. Neurology. 1992;42(1):183-8. (Level III evidence). View the reference
  24. Pantel J, Schroder J, Schad LR, Friedlinger M, Knopp MV, Schmitt R, et al. Quantitative magnetic resonance imaging and neuropsychological functions in dementia of the Alzheimer type. Psychol Med. 1997;27(1):221-9. (Level III evidence). View the reference
  25. Vanneste J, Augustijn P, Tan WF, Dirven C. Shunting normal pressure hydrocephalus: the predictive value of combined clinical and CT data. J Neurol Neurosurg Psychiatry. 1993;56(3):251-6. (Level III evidence). View the reference
  26. Daniela P, Orazio S, Alessandro P, Mariano NF, Leonardo I, Pasquale Anthony DR, et al. A survey of FDG- and amyloid-PET imaging in dementia and GRADE analysis. Biomed Res Int. 2014;2014:785039. (Level II evidence). View the reference
  27. Marcus C, Mena E, Subramaniam RM. Brain PET in the diagnosis of Alzheimer's disease. Clin Nucl Med. 2014;39(10):e413-22; quiz e23-6. (Review article)
  28. Bloudek LM, Spackman DE, Blankenburg M, Sullivan SD. Review and meta-analysis of biomarkers and diagnostic imaging in Alzheimer's disease. J Alzheimers Dis. 2011;26(4):627-45. (Level I evidence)
  29. Ishii K. PET Approaches for diagnosis of dementia. AJNR Am J Neuroradiol. 2014;35(11):2030-8. (Review article). View the reference
  30. Ng S, Villemagne VL, Berlangieri S, Lee ST, Cherk M, Gong SJ, et al. Visual assessment versus quantitative assessment of 11C-PIB PET and 18F-FDG PET for detection of Alzheimer's disease. J Nucl Med. 2007;48(4):547-52. (Level III evidence). View the reference
  31. Zhang S, Han D, Tan X, Feng J, Guo Y, Ding Y. Diagnostic accuracy of 18 F-FDG and 11 C-PIB-PET for prediction of short-term conversion to Alzheimer's disease in subjects with mild cognitive impairment. Int J Clin Pract. 2012;66(2):185-98. (Level I evidence)
  32. Rabinovici GD, Rosen HJ, Alkalay A, Kornak J, Furst AJ, Agarwal N, et al. Amyloid vs FDG-PET in the differential diagnosis of AD and FTLD. Neurology. 2011;77(23):2034-42. (Level II evidence). View the reference
  33. Vandenberghe R, Adamczuk K, Van Laere K. The interest of amyloid PET imaging in the diagnosis of Alzheimer's disease. Curr Opin Neurol. 2013;26(6):646-55. (Review article). View the reference
  34. Okello A, Koivunen J, Edison P, Archer HA, Turkheimer FE, Nagren K, et al. Conversion of amyloid positive and negative MCI to AD over 3 years: an 11C-PIB PET study. Neurology. 2009;73(10):754-60. (Level II evidence). View the reference
  35. Davison CM, O'Brien JT. A comparison of FDG-PET and blood flow SPECT in the diagnosis of neurodegenerative dementias: a systematic review. Int J Geriatr Psychiatry. 2014;29(6):551-61. (Review article). View the reference
  36. Yeo JM, Lim X, Khan Z, Pal S. Systematic review of the diagnostic utility of SPECT imaging in dementia. Eur Arch Psychiatry Clin Neurosci. 2013;263(7):539-52. (Level I evidence). View the reference
  37. Larsson A, Arlig A, Bergh AC, Bilting M, Jacobsson L, Stephensen H, et al. Quantitative SPECT cisternography in normal pressure hydrocephalus. Acta Neurol Scand. 1994;90(3):190-6. (Level II evidence). View the reference

{tab=Information for Consumers}

Information for Consumers


Information from this website


Information from the Royal Australian and New Zealand College of Radiologists’ website



Consent to Procedure or Treatment


Radiation Risks of X-rays and Scans


Computed Tomography (CT)


Magnetic Resonance Imaging (MRI)


Positron Emission Tomography (PET)



Computed Tomography (CT)


Contrast Medium (Gadolinium versus Iodine)


Gadolinium Contrast Medium


Iodine-Containing Contrast Medium


Magnetic Resonance Imaging (MRI)


Plain Radiography/X-rays


Radiation Risk of Medical Imaging During Pregnancy


Radiation Risk of Medical Imaging for Adults and Children


Cerebral Perfusion Study


Nuclear Medicine


PET Scan


SPECT-CT Scan


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Copyright

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